Written by: John Lynn
Eligibility for Pay-for-Performance
I think that this is a really scary topic for most doctors. It’s not that a doctor is afraid of being reimbursed for the way they perform. The problem with pay for performance (ACO if you prefer) is that we have no idea what that’s really going to look like. The unknown is scary and a real problem. A change as dramatic from fee for service to pay for performance is an enormous shift and we still have very little idea how that shift is going to happen.
However, as one person told me, “That train (the shift to pay for performance) has already left the station.” In fact, I was talking with the former CEO of a major EMR vendor and he suggested that the shift is going to happen a lot faster than most of us realize. If we assume that this shift is going to happen, then doctors and healthcare better be prepared.
I believe having an EMR will be the only way a clinic can participate in pay for performance.
I make this assertion, because how else are payers going to measure your performance if they don’t have the data on how you’re performing? I’ve never thought of this before, but the EMR could become the performance measurement tool for doctors. Trying to flintstone your performance in a paper world is just not going to happen. The data collected in an EMR (and possibly other software) is going to drive the performance metrics which will drive the payments.
Think about what that means to a clinic. If you don’t have an EMR, you will miss out on the pay for performance payments.
I imagine many that read this will discount the shift that’s going to happen. That’s a fair position to take, but one that I think will come back to bite you. If the shift in payments doesn’t happen, then you won’t have to worry. However, if the shift to pay for performance has left the station, then you’re going to be at a tremendous disadvantage.
Healthcare data is going to drive a lot of things in the future of healthcare. Pay for performance is one of those things. Physicians who don’t have that data available in an EMR or other electronic format are going to face stiff challenges.